Helpful Guidance

Someone you love is dying

Although it is impossible to totally prepare for a death, a death may be made easier if you know what to expect. This pamphlet may be helpful in preparing you as family and/or caregiver to understand the final stage of life. It is important to discuss your concerns and fears with those around you, both your family and health care providers. These people can help you make choices with or for your loved one and can inform you about other services that are available to support you.

Death is a natural process as the body begins shutting down. The following physical and emotional signs of approaching death are described to help you understand what can happen. Not all these signs and symptoms will occur with every person nor will they occur in any particular sequence.

This section is intended only as a guide. It is not intended to replace advice given by a health care professional, such as a nurse, physician, clergy, social worker, CCAC case manager or pharmacist.

Helpful Hints

It is helpful to plan ahead. Know what your loved one's wishes are so that they are respected. Making funeral arrangements in advance reduces the number of decisions that will need to be made right at the time of death. It also provides an opportunity to talk about arrangements, concerns and feelings.

Physical Signs of Approaching Death

Reduced Food & Fluid Intake:

Loss of appetite and decrease in thirst are common. The body is beginning to shut down and does not need nourishment. People commonly feel it is necessary to encourage the person to eat in the hope of sustaining life; however, food and fluid may cause discomfort. The person may ask for ice chips, popsicles, ice cream or some other food choice. Do not be surprised if only a mouthful or two is taken. When swallowing is no longer possible, mouth care provides moisture and comfort. Do not offer a fluid if swallowing is not possible.

Sleeping:

Sleeping an increased amount of time is common. It may become more difficult to waken the person. As death nears, the person may slip into a coma and become unresponsive.

Restlessness And Disorientation:

Confusion as to time, place and recognition of people, even family members and close friends is common. At times your loved one may become restless. For example, he/she may reach out to unseen objects, pull at bedclothes or try to get out of bed. This can occur for many reasons such as lack of oxygen circulation to the brain or changes in condition or medications. It would be helpful to discuss these changes with a health care professional.

Changes In Breathing:

Regular breathing patterns may change. Breathing may stop for 10 to 30 second periods or there may be periods of rapid, shallow panting. These breathing patterns are normal and indicate the natural progression towards death. A moaning sound occurs as the breath passes over the relaxed vocal cords.

Congestion:

Gurgling sounds, often loud, occur when a person is unable to cough up normal secretions. This does not normally cause pain or discomfort. It may be helpful to turn the person to one side and gently wipe away secretions with a moist cloth. As secretions build up, keeping the head of the bed elevated (by using pillows) will make breathing easier. Sometimes medications can be ordered to help dry up secretions. Oral suctioning may be done; however, this usually causes an increase in secretion production.

Skin:

You may notice the skin begin to change color and become cooler to touch. The face may be pale and the feet and legs a purple-blue mottled color. The circulation of the blood is slowing down. Although your loved one is cool to touch, he/she is usually comfortable. Offer a warm blanket but avoid using an electric blanket to prevent the risk of skin burns.

Social & Emotional Signs of Approaching Death

As death approaches, the person becomes quieter and less interested in physical surroundings. He/she may become withdrawn, less sociable and also be confused about time and place.

Vision like experiences may occur. The person may see or speak to people and places not visible to you. Try not to explain away what the person is saying. Be supportive by listening to the person.

The person dying may be going through different emotional states such as guilt, anger frustration, helplessness or sadness. Tears are a natural expression of one's feelings and may occur in both the person and his/her family.

Spirituality & Cultural Rituals:

People vary greatly in their spiritual and religious beliefs and needs. During this time a member of the clergy, chaplain or a spiritual advisor can provide support to both the dying person and the family.

It may be helpful for you to attend to your own special cultural needs at this time.

How will I know Death has Occured

Even though death is expected, you may not be prepared for the actual moment it occurs. At the time of death:

There will be no response

There will be no breathing

There will be no pulse

Eyes will be fixed in one direction

Eyelids may be opened or closed

There may be loss of control of the bladder or bowel

The procedures followed prior to and after death by nurses, physicians and funeral directors will be different from County to County, Province to Province and State to State. If your loved one is living with a terminal disease you should ask your physician and funeral director what the procedures are in your area.

REMEMBER THIS IS AN EXPECTED DEATH AND NO FURTHER MEDICAL INTERVENTION IS REQUIRED

DO NOT CALL 911, THE POliCE, OR THE FIRE DEPARTMENT

Organ and Tissue Donation

In practice, donations cannot be carried out without the consent of next-of-kin. Advance discussion of donation with family members is just as important as signing a card. In a time of extreme stress and grief, a signed donor card and knowledge of the individual's wishes will help families make their decision about donation.

Who can become a donor?

Anyone who is 18 or older and of sound mind may become a donor when he or she dies. Minors may become donors with a parent's or guardian's consent.

Will my decision interfere with my own health care?

No. Medical personnel must follow strict guidelines before they can pronounce death and remove the donor's organs and tissues. Organ and tissue donors receive the same health care as non-donors.

How will medical personnel know that I am a donor?

Medical personnel will know by your carrying of a " Donor Card". You should distribute copies to your family, doctors, funeral home that holds your pre-arranged services and attorney.

Who pays for the donation procedure?

The organ donation programs, funded through health care, pay for all costs involved in the organ donation and recovery.

How are the organs and tissues distributed?

The distributions of organs is handled by regional organ banks which are linked to a national computer network that allows them to speed the process of matching organ donors and recipients. Tissue distribution is coordinated by various tissue banks throughout the country.

Does my age or medical history matter?

Although most programs do have age restrictions for organs, it should not influence your decision to become a donor. The transplant team will decide at the time of donation whether the organs or tissues are useful for donation. If the organs or tissues can't be transplanted, it is possible that the organs or tissues may be helpful in medical research.

Will I have to change my funeral arrangements?

Within reason, organ donation does not delay funeral arrangements or disfigure the body, so no changes will be needed in your funeral plans. If you plan to donate your body for medical research, you should be sure to arrange all of the details with your local anatomical board.

Can I change my mind about becoming a donor?

Absolutely, simply tear up your donor card. Anyone that you have told about your donation request should be notified of this change. Tell family members, doctors, funeral home, and if you have made arrangements to have your status indicated on your driver's license be sure to contact the driver's license office to have your status changed.

Writing an Obituary

What Is An Obituary?

More than merely a 'good-bye' to the deceased, this is a farewell which can, in chronological order, detail the life of the deceased. An obituary also serves as notification that an individual has passed away and details of the services that are to take place. An obituary's length may be somewhat dictated by the space available in the newspaper it is to appear in. Therefore it's best to check how much room you have before you begin your composition. Remember that the obituary needs to appear in print a few days prior to the memorial service. There are some cases where this may not be possible, therefore give some consideration to the guidelines below when composing the obituary.

What To Include?

Naturally, it is vital that the full name, along with the location and date of passing is included so that there is no confusion over whom has died. You may wish to consider placing a photograph (which can appear as black & white or in color depending on the newspaper's layout) with the text. There are usually extra charges applied if you are thinking of using a photograph. If you wish, mention where the deceased resided. This will normally only include the street, city and region/state/province/county. The street number is not normally included for reasons of security.

In a concise manner, write about the significant events in the life of the deceased. This may include the schools he or she attended and any degrees attained; you may also include any vocations or interests that the deceased was involved with.

Survivors

It is common to include a list of those who have survived the deceased. The list should include (where applicable):

Parents

Spouse and children

Adopted children

Half & step children

Siblings

Half & step siblings

Grandparents

The surviving relatives listed above may be listed by name. Other relatives will not be mentioned by name but may be included in terms of their relationship to the deceased. In other words, the obituary may mention that the deceased had 5 grandchildren; 7 nieces etc. However, exceptions to the above rule can be made if, for example, the deceased only had one grandchild or a nephew who was the only person living in the newspaper's distribution area. These exceptions are obviously made based on each individual case.

Also, anyone listed as a special friend or companion is not normally included amongst the list of survivors unless the deceased's blood relatives request that it be so. The obituary's traditional purpose is to list survivors either related through the bloodline or marriage.

Additional information such as where the body will be laid to rest and any pallbearer's names or names of honorary pallbearer's may be mentioned.

At this point list the details of the time and location of any services for the deceased: these may include the funeral, burial, wake and memorial service where appropriate.

Some Do's & Dont's

If you don't know where to start, do read other obituaries to gain an idea of how personal and touching an obituary may be.

Do use such terms as "visitation will be from" or "friends may call from". Do not utilize the phrase "lie in state" as that only applies to a head of state such as the prime minister or president.

Don't use the phrase "in lieu of flowers…" when memorial donations are to be requested. Instead merely start the final paragraph of the obituary with the words "Memorial donations may be made to…"

Do consider if you wish to send the obituary to newspapers in other cities e.g. to a town where the deceased may have resided previously. Obtain copies of the obituary to send to distant relatives and friends.

Final Considerations

Any and all information to be included in the obituary should be verified with another family member. A newspaper will have to verify with the funeral home being utilized that the deceased is in fact being taken care of by that funeral home.

Seeing as most newspapers charge by the word when placing an obituary, it may not always be feasible to mention everything that we have stated in our guidelines. Use your own discretion and do not put yourself under any financial hardship. Your loved one would understand.

The Eulogy

Writing and delivering a eulogy is a noble gesture that is worthy of thought and effort. It is an opportunity to make a contribution to a memorial service a contribution that your friends and family will remember for a long time.

Writing in general a eulogy, a tribute, a letter, or keeping a journal presents another equally valuable opportunity for you. The ability to use the writing process as a therapeutic tool to help you deal with your grief. The power of writing is undeniable and there is no better time than now for you to discover and take advantage of this.

What A Eulogy Should Accomplish

There are two common misconceptions about the purposes of a eulogy. Some people think: 1) it should be an objective summation of the deceased's life; or 2) it should speak for everyone who is present at the memorial service. Both of these assumptions are unrealistic.

A eulogy is much more simple. It should convey the feelings and experiences of the person giving the eulogy. The most touching and meaningful eulogies are written from a subjective point of view and from the heart. So don't feel compelled to write your loved one's life story. Instead, tell your story.

Clearly, the burden of the eulogy does not have to be yours completely. If you have the time, ask friends or relatives for their recollections and stories. In a eulogy, it is perfectly acceptable to say, for example, "I was talking to Uncle Lenny about Ron; he reminded me of the time Ron came to our Thanksgiving dinner with half of his face clean-shaven and the other half bearded. It was Ron's funny way of showing that he had mixed feelings about shaving off his beard."

Honesty is very important. In most cases, there will be a lot of positive qualities to talk about. Once in a while, however, there is someone with more negative traits than positive qualities. If that is the case, remember, you don't have to say everything. Just be honest about the positive qualities and everyone will appreciate the eulogy.

Remember, you do not have to write a perfect eulogy. Whatever you write and deliver will be appreciated by the people at the funeral. If you are inclined to be a perfectionist, lower your expectations and just do what you can, given the short time frame for preparation and your emotional state.

Tips For Delivering A Eulogy

If you decide to write a eulogy and deliver it, realize that it may be the most difficult speech you will ever make; and it may be the most rewarding. It is important to realize that people are not going to judge you. They will be very supportive. No matter what happens, it will be okay. If you break down in the middle of your speech, everyone will understand. Take a moment to compose your self, and then continue. There is no reason to be embarrassed. Remember, giving a eulogy is a noble gesture that people will appreciate and admire.

If you can, make the eulogy easy to read. On a computer, print out the eulogy in a large type size. If you are using a typewriter, put extra carriage returns between the lines. If you are writing it by hand, print the final version in large letters and give the words room to breath by writing on every second or third line.

Before the service, consider getting a small cup of water. Keep it with you during the service. When you go to the podium to deliver the eulogy, take the water with you in case you need it. Sipping water before you start and during the speech, if needed-will help relax you. If you are nervous before delivering the eulogy, breath deeply and tell yourself that everything will be fine. It will be. Look around at your relatives and friends and realize that they are with you 100 percent. Realize that it is acceptable to read the eulogy without making eye contact with the audience, if that would be easier for you. Take your time. Do the best you can. No one expects you to have the delivery of a great orator or the stage presence of an actor. Just be you.